Effects of Peer Education and Orientation Tour on Anxiety in Patient Candidates for Coronary Angiography

Background: Coronary angiography is a stressful procedure for most patients. The physiological responses caused by anxiety during coronary angiography increase the likelihood of dysrhythmia, coronary artery spasm, and rupture. Objectives: This study compared the effects of peer education and an orientation tour on anxiety in patients who were candidates for coronary artery angiography. Patients and Methods: This single blind quasi-experimental study was conducted in 2014. A total of 177 patients who were candidates for coronary artery angiography were divided into three groups: a peer education group, an orientation tour group, and a control group. The patients in the peer education group were trained by a peer educator, and the patients in in the orientation tour group were trained by the researcher, who worked in the angiography unit. The DASS-21 questionnaire was used to measure the patients’ anxiety levels before the intervention and two hours before undergoing the coronary angiography. The data were analyzed using a Chi-square test, analysis of variance, the Kruskal-Wallis, Wilcoxon, Mann-Whitney U tests, and an interquartile range. Results: The three groups did not significantly differ regarding the mean anxiety scores before the intervention. However, a significant difference was observed between the mean anxiety scores of the three groups after the intervention (P = 0.0001). In the peer education group, the mean anxiety score was 5.34 ± 2.52 and decreased to 3.69 ± 2.87 after the intervention (P = 0.0001). In the orientation tour group, the mean anxiety was 5.53 ± 3.49, which and changed to 3.10 ± 2.22 (P = 0.0001). However, the mean anxiety score significantly increased in the control group (5.66 ± 2.94 vs. 6.53 ± 3.43, P = 0.017). Conclusions: Both methods of peer education and orientation tour decreased the anxiety levels in patients undergoing coronary artery angiography. Therefore, these approaches should be carried out according to the hospital condition and facilities

Informal Payments for Outpatient Health Care: Country-Wide Evidence from Iran

Background: Reliance heavily on out-of-pocket (OOP) payments, including informal payments (IPs), has undesired effects on financial risk protection and access to care. While a significant share of total health expenditure is spent on outpatient services, there is scant evidence of the patient's amount paid informally in outpatient services. Such evidence is available for inpatient services, showing the high prevalence of informal payments, ranging from 14 to 48% in the whole hospital. This study aimed to investigate the extent of OOP and IPs for outpatient services in Iran. Methods: A secondary data analysis of the 2015 IR Iran's Utilization of Healthcare Services (IrUHS) survey was conducted. A sample of 11,782 individuals with basic health insurance who were visited at least once by a physician in two private and public health care centers was included in this analysis. The percentage of OOP was determined and compared with the defined copayment (30%). The frequency of IPs was determined regarding the number of individuals who paid more than the defined copayments. The Mann-Whitney test also investigated the relationships between OOP percentage and IPs frequency with demographic variables. Results: The share that insured patients in Iran pay for a general practitioner (GP) visit was 38% in public versus 61% in the private sector, while for a specialist practitioner visit, the figures were 80% and 96%, respectively, which is higher than defined copayment (30%). This share was significantly higher in females, urban areas, highly educated people, private service providers, and specialist visits. The frequency of IPs, who paid more than the defined copayments, was 73% for a GP in public versus 86% in the private sector, while for a specialist practitioner visit, these were 90% and 93%, respectively. Conclusion: Informal patient payments for outpatient services are prevalent in Iran. Hence, more interventions are required to eliminate or control the IPs in outpatient services, particularly in the private sector. In this regard, making a well-regulated market, reinforcing the referral system, and developing an equity-oriented essential health services package would be fundamenta

Sex Cord-Gonadal Stromal Tumor of the Rete Testis

A 34-year-old tetraplegic patient with suppurative epididymitis was found on follow-up examination and ultrasonography to have a testicular mass. The radical orchiectomy specimen contained an undifferentiated spindled sex cord-stromal tumor arising in the rete testis. Testicular sex cord-stromal tumors are far less common than germ cell neoplasms and are usually benign. The close relationship between sex cords and ductules of the rete testis during development provides the opportunity for these uncommon tumors to arise anatomically within the rete tesis. This undifferentiated sex cord-stromal tumor, occurring in a previously unreported location, is an example of an unusual lesion mimicking an intratesticular malignant neoplasm

Pilomyxoid astrocytoma of the spinal cord in an adult

Summary: We report a 45-year old woman with a pilomyxoid astrocytoma (PMA) of the cervical spinal cord with a rapid clinical course and fatal outcome. Moreover, two family members of the patient were reported to have brainstem tumours with similar histopathological features. This may be the first report of familial PMA

The State of Food Insecurity and Its Relationship with the Physical and Mental Health of the Elderly (Sanandaj, 2019)

Background and Objective: Food insecurity is defined as limited or uncertain access to adequate and healthy food in terms of nutrition or limited ability to obtain food in socially acceptable ways, which can affect the health of the elderly. The aim of this research is to investigate the state of food insecurity and the factors affecting it and its role in physical and mental health in the elderly. Methods: This cross-sectional study was conducted on 550 elderly people aged 60 years and older who referred to 10 health centers in Sanandaj, and were selected via random cluster sampling. Demographic information questionnaire, HFIAS food security questionnaire (8 questions with a score range of 0 to 24) and Goldberg General Health Questionnaire (28 questions with 4 subscales) were completed and reviewed. Findings: In this study, 324 elderly women and 224 men were evaluated, 75.6% were married and 73.6% were illiterate. The findings showed that 59.1% (325 people) of the elderly had some degree of food insecurity and severe insecurity was observed in 62 people (11.3%). Food insecurity in people with moderate to severe physical symptoms (OR=7.33), anxiety and sleep disorder (OR=8.63), functional disorder (OR=6.78), depression (OR=21.12) and in general, moderate to severe general health disorder (OR=11.85) was seen more. In addition, food insecurity, not being married, being illiterate, living alone, and low income were observed to a greater extent in women. Conclusion: The results of the study showed that the prevalence of food insecurity among the elderly in Sanandaj is significant and is related to factors such as general, physical and mental health disorders

Determination of heavy metal (lead and cadmium) concentrations in liver and muscle tissue of Indian mackerel (Rastrelliiger kanagurta) in Persian Gulf

This study was conducted to compare heavy metal concentrations including lead and cadmium in liver and muscle tissues of Indian mackerel (Rastrelliiger Kanagurta) in Bandar Lengeh, Hormoz island, Hengam island and Kolahi regions. In current research, the influence of season, sex and size (length and weight) on Pb and Cd concentrations in Indian mackerel was investigated in these areas. Then Lead and cadmium concentrations in muscle tissues were compared with international standards for human consumption. Sampling was performed in summer and winter. Metal concentrations of organs were assessed by dry digestion method and atomic absorption spectrometer (AAS). Results showed that there are statistically significant differences between concentrations of lead and cadmium in liver and tissues of the fish in these regions (Bandar Lengeh, Hormoz, Hengam and Kolahi) (p0.05). In addition, there is no correlation between lead and cadmium concentrations in muscle and liver of Indian mackerel with size (length and weight) (p>0.05)